The 1996 Safe Drinking Water Act amendments require the US Environmental Protection Agency and the Centers for Disease Control and Prevention to develop a national estimate of the occurrence of waterborne infectious disease that is attributable to public drinking water systems in the United States. Much of the information for developing the national estimate will be derived from epidemiologic data, and the primary outcome of this effort will be an estimate of the number of cases of gastrointestinal illness. While quantifying the number of these cases provides some measure of waterborne disease impact, the usefulness of this measure may be limited because the full spectrum of societal impact also involves consideration of the additional effects of these diseases such as hospitalization costs and lost productivity. If decision-makers wish to compare the impact of waterborne infectious diseases to the impact of some other public health concern (e.g. to aid in resource allocation decisions), then a comparison of case numbers may prove inadequate. Case numbers alone do not provide sufficient information about the severity of different illnesses. Society may value the avoidance of a few cases of severely debilitating illness more than it values the avoidance of many cases of mild illness. In order to compare disparate public health concerns, “burden of disease” measures that incorporate indicators of disease severity, costs, or societal values may prove essential for some types of decisions. We describe epidemiologic measures of severity, quality adjusted life years (QALYs), disability adjusted life years (DALYs), willingness-to-pay, and cost-of-illness methods commonly used for burden of disease estimates, and discuss how some of these summary measures of burden might be used for waterborne disease estimates.
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Research Article|
December 01 2006
The role of disease burden measures in future estimates of endemic waterborne disease
Glenn Rice;
1US Environmental Protection Agency, 26 W. Martin Luther King Dr. (MS-A110), Cincinnati OH 45268, USA
E-mail: [email protected]
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Matthew T. Heberling;
Matthew T. Heberling
1US Environmental Protection Agency, 26 W. Martin Luther King Dr. (MS-A110), Cincinnati OH 45268, USA
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Mary Rothermich;
Mary Rothermich
1US Environmental Protection Agency, 26 W. Martin Luther King Dr. (MS-A110), Cincinnati OH 45268, USA
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J. Michael Wright;
J. Michael Wright
1US Environmental Protection Agency, 26 W. Martin Luther King Dr. (MS-A110), Cincinnati OH 45268, USA
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Patricia A. Murphy;
Patricia A. Murphy
1US Environmental Protection Agency, 26 W. Martin Luther King Dr. (MS-A110), Cincinnati OH 45268, USA
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Michael F. Craun;
Michael F. Craun
2Gunther F. Craun and Associates, 101 West Frederick Street, Suite 207, Staunton VA 24410, USA
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Gunther F. Craun
Gunther F. Craun
2Gunther F. Craun and Associates, 101 West Frederick Street, Suite 207, Staunton VA 24410, USA
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J Water Health (2006) 4 (S2): 187–199.
Citation
Glenn Rice, Matthew T. Heberling, Mary Rothermich, J. Michael Wright, Patricia A. Murphy, Michael F. Craun, Gunther F. Craun; The role of disease burden measures in future estimates of endemic waterborne disease. J Water Health 1 December 2006; 4 (S2): 187–199. doi: https://doi.org/10.2166/wh.2006.023
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